First PSA following prostatectomy.

JohnK11 said:

Sadly to say, mine was higher
Re : High PSA after treatment and
my experience on hormone treatment (10-month report)

I am one of the least lucky prostate cancer patient
(I've only seen a few people with comparable or worse
experience). After Robotic surgery, my PSA DID NOT go down,
and stayed at 7 (retest 2 weeks later at 9.2 --> 2+ month
doubling time).
Since the PSA was so high, and doubling time short,
I did not even consider SRT (unlikely that all the cancer
is nearby the removed prostate)
If the spread is far away (bone, far away lymph nodes, etc.) no initial treatment
will impact that. Furthermore, any diagnostics when your PSA is low (below
20-40) will unlikely find far-away cancer, since it is likely to be too small
(I think I wasted the effort in bone scan, CT scan, and MRI/prostascint scan,
since at that time, my PSA was only 7).

However, hormone treatment seems to be working.
The uro claim 5-8 years of effectiveness, but that might
be optimistic. There are treatments beyond that, but
some of the side effects are horrendous (I don't think I
want to go chemo just to extend my life by 2-4 months).
The side effects of hormone seems to be okay --hot flashes are
a bother, but I got used to it.
I still live an reasonably active life--go to work
every weekday (fortunately, office job), play singles tennis
(not as rigorously as before, but I am getting older), walk
a lot, not other serious side effects (perhaps having trouble
getting full 8 hours of sleep since I tend to get up every
2 hours to pee--still some urinary leakage).
So, as long as the hormone (intermittent) treatment
works, I am going on with my life as before. My attitude is
that I have lived a reasonably full life, been involved with
a few discoveries (bottom and top quark), so will like a full
life until I go. Cheers.

---------------------------
PC history
4/09 Pre-biopsy PSA 4.2 (this triggered the
7/09 biopsy 4+3=7 Gleason prostate cancer)
10/09 Pre-surgery PSA 6.7
10/9/09 DaVinci surgery (Gleason 4+3=7; T3c; right seminary
vesicle cancerous; has to remove that AND "way beyond the
prostate" to get negative margin)
11/30/09 6 weeks post surgery 7.0/6.4
12/13/09 8 weeks post surgery 9.2 (doubling time 2+ months)
12/16/09--took Trelstar (Lupron surrogate)
3/3/10 <.1 (testoserone 13)
3/15/10 --took 2nd Trelstar LA shot
6/10 PSA <.1
8/1/10 --took 3rd Trelstar LA shot (plan to go intermittent)

12/09 Both the Bone scan and the Prostascint/MRI scans were
negative (the uro says that most of the time, one would
not see cancerous modules in these scans until your PSA is
~40+.</p>

1st Post Prostatectomy PSA 26
Hi,
My husband had a robotic prostatectomy on Feb.3,2011. Prior he had neg DRE but a rising PSA (6,9,14). He missed a year of having his psa done which was 0.2 the year before. Neg. ultrasound of pelvis. , Neg. prostate biopsy. Had 3 T. MRI revealing small tumor in prostate, possibly one lymph node involved. Needle guided prostate bx using MRI REPORT REVEALED 2 pos cores. Gleason score of 8. Bone scan neg. Post surgical pathology report reveal post margins, one regional lymph node involvement. 1st post op PSA at 4 weeks was 26. My husband will speak to his urologist tomorrow about elevated post surgery PSA. I think he should also find a medical oncology.

Good luck with your numbers and your perspective on life is very inspirational to us.

JohnK11 said:

Sadly to say, mine was higher
Re : High PSA after treatment and
my experience on hormone treatment (10-month report)

I am one of the least lucky prostate cancer patient
(I've only seen a few people with comparable or worse
experience). After Robotic surgery, my PSA DID NOT go down,
and stayed at 7 (retest 2 weeks later at 9.2 --> 2+ month
doubling time).
Since the PSA was so high, and doubling time short,
I did not even consider SRT (unlikely that all the cancer
is nearby the removed prostate)
If the spread is far away (bone, far away lymph nodes, etc.) no initial treatment
will impact that. Furthermore, any diagnostics when your PSA is low (below
20-40) will unlikely find far-away cancer, since it is likely to be too small
(I think I wasted the effort in bone scan, CT scan, and MRI/prostascint scan,
since at that time, my PSA was only 7).

However, hormone treatment seems to be working.
The uro claim 5-8 years of effectiveness, but that might
be optimistic. There are treatments beyond that, but
some of the side effects are horrendous (I don't think I
want to go chemo just to extend my life by 2-4 months).
The side effects of hormone seems to be okay --hot flashes are
a bother, but I got used to it.
I still live an reasonably active life--go to work
every weekday (fortunately, office job), play singles tennis
(not as rigorously as before, but I am getting older), walk
a lot, not other serious side effects (perhaps having trouble
getting full 8 hours of sleep since I tend to get up every
2 hours to pee--still some urinary leakage).
So, as long as the hormone (intermittent) treatment
works, I am going on with my life as before. My attitude is
that I have lived a reasonably full life, been involved with
a few discoveries (bottom and top quark), so will like a full
life until I go. Cheers.

---------------------------
PC history
4/09 Pre-biopsy PSA 4.2 (this triggered the
7/09 biopsy 4+3=7 Gleason prostate cancer)
10/09 Pre-surgery PSA 6.7
10/9/09 DaVinci surgery (Gleason 4+3=7; T3c; right seminary
vesicle cancerous; has to remove that AND "way beyond the
prostate" to get negative margin)
11/30/09 6 weeks post surgery 7.0/6.4
12/13/09 8 weeks post surgery 9.2 (doubling time 2+ months)
12/16/09--took Trelstar (Lupron surrogate)
3/3/10 <.1 (testoserone 13)
3/15/10 --took 2nd Trelstar LA shot
6/10 PSA <.1
8/1/10 --took 3rd Trelstar LA shot (plan to go intermittent)

12/09 Both the Bone scan and the Prostascint/MRI scans were
negative (the uro says that most of the time, one would
not see cancerous modules in these scans until your PSA is
~40+.</p>

1st Post Prostatectomy PSA 26
Hi,
My husband had a robotic prostatectomy on Feb.3,2011. Prior he had neg DRE but a rising PSA (6,9,14). He missed a year of having his psa done which was 0.2 the year before. Neg. ultrasound of pelvis. , Neg. prostate biopsy. Had 3 T. MRI revealing small tumor in prostate, possibly one lymph node involved. Needle guided prostate bx using MRI REPORT REVEALED 2 pos cores. Gleason score of 8. Bone scan neg. Post surgical pathology report reveal post margins, one regional lymph node involvement. 1st post op PSA at 4 weeks was 26. My husband will speak to his urologist tomorrow about elevated post surgery PSA. I think he should also find a medical oncology.

Good luck with your numbers and your perspective on life is very inspirational to us.

ralph.townsend1 said:

Specialist
Make sure you have the right people looking at this! You only get few chance! These local Doctor's can miss thing's Go to a specialist like MD Anderson in Houston or some place. I went to a Local Oncology doctor, he specialize in cancer , not Prostate cancer!!!

Then my Urologist told me of MD Anderson cancer Center. The best in the world or close to it. I went from Dallas to Houston and everything was schedule for the same day testing, That was 4 years ago and I have maybe another 5 years or longer :-) My Gleason was 4+5 and is in the Lymph nodes. They have a specialist for prostate and they have the best med's.

But my point is get to a place that know's!!!!

1st post prostatectomy PSA 26
Thanks Ralph,
We are following up with medical oncologist specializing in prostate cancer at Sloan-Kettering Cancer Institute. Could it be testosterone flair?? He received his first dose of Trelstar right after his blood was drawn for his 1st PSA

ralph.townsend1 said:

GREAT
It's looks like the right place. :-)

My prayer's will be with you!

Stay in contact!!!

Suspicious elevated PSA post-op
Dream

I wonder if there is any mistake in the results units presented to you. It is hard to believe that the PSA got so elevated after surgery, from 0.2 to 26.
Ralph is passing sound advice regarding the place where your husband is being cared. MSKCC is one of the prime hospitals treating prostate cancer and they will give you the best answers. Trelstar agonist could cause a flare in PSA if taken BEFORE drawing blood which I believe that is not the case. Such mistake would not be "expected from MSKCC professionals.
Nevertheless, why should your husband been put on hormonal drugs just after surgery? Does his protocol include a combine treatment?
Did he in fact had a prostatectomy?

I hope the folks at MSKCC will give the explanation and peace of mind.

Best to you both.
VGama

DreamV said:

1st Post prostatectomy elevated PSA
Hi VasodaGama,
Yes he did have e daVinci robotic prostatectomy. How soon after surgery should hormonal therapy begin? His TNM was pT2c,N1,cM0. Lymph-vascular invasion. Thanks for all your info and he plans to repeat his PSA. Will kep all posted.

ConcomitantTreatment protocol ?
Dream

I would like to help you in understanding the status of your husband, but you need to confirm some of the info you posted and add details regarding his doctor’s treatment protocol.

What is the Gleason score ?
Have you mistaken the date of surgery?

You have indicated that his surgery was done in Feb 2011 (one year ago ?) and that at 4 weeks post-op the PSA come as 26 (ng/mL ????), and that he was given a Trelstar injection.
I understand his pathological stage pT2c,pN1,pM0 (Lymph-vascular invasion) and the series of negative scans and tests done before surgery but would like to know why did the doctor decide on the adjuvant hormonal treatment.

Was the decision due to extra capsular extension at the Lymph nodes?
Or was it part of the initial protocol?
His your husband involved in a trial?

Concomitant systemic therapies are usually done to improve the prognosis of a prime treatment (surgery in your case). In such cases, the start of the HT has no established protocol, but if HT is done as a sort of salvage treatment then it is usually started once recurrence is declared. The behaviour of PSA tests would be considered to decide on a date.

Here is a link on the matter; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472854/

I hope MSKCC will "clear" your doubts.

Please let us know about your findings.

Regards
VGama

DreamV said:

First post prostatectomy PSA
Hi Vasco,

Sorry about the date. Now to answer your questions:
1. Gleason score 4+3=7
2. Surgery : Feb. 3, 2012
3. Pre-op PSA 19. First post op PSA at 4 weeks 26.7
4. Pathological stage: pT2c, N1, cM0
5. No capsular extension but metastatic carcinoma in 1 of 2 lymph nodes, following carcinoma of prostate gland

Because of mets to lymph node Trelstat injection started.
He is not involved in any trials.
My understanding is usually after a prostatectomy PSA LEVELS DROP to < 0.1. You want to see some zeros right? But in his case it rose.

He spoke to his urologist last night about the high PSA number and was told it could be residual and not to seek out a medical oncologist as of yet because he didn't need any other medications as of yet. He wants him to have another PSA in 6 weeks. However, I talked him into having it done in 2 weeks. Now that he has had one shot maybe it will still be elevated due to testosterone flair. In the meantime he has an appoint with a medical oncologist after that second PSA. I just fear hat he has the aggressive type because prior to surgery his numbers were increasing quite rapidly.

Thanks for your input as I am at my wits end.

Another bump in your journey
Dream

I am sorry to read about the prognosis. You are absolutely correct in seeking a consultation with a medical oncologist. You should get a copy of the path report to show him. Try to get someone that is specialized.

Your suspicious are also correct, in my opinion. The PSA should go down to <0.1 after removal of the prostate. PSA=26.7 at 4 weeks and the classification of pT2c do not fit at all. One should expect positive extensions not only at lymph nodes but in the tissues surrounding the prostate (T3a or b). It is difficult to believe that folks at MSKCC would pass you erroneous results but when suspicious exits, in your shoes I would seek a second opinion on the prostate specimens. Surely by doing so the newer revelation would not alter the treatment but you would have in your possession the real status which is important data for future actions.

Getting a PSA done at two weeks is a good step and probably it will show already a drop because the flare is common to occur within a maximum of 14 days post administration of the shot. In any case the agonist will influence the PSA result so that it would not serve you at this time to judge the progress of the disease. BOL, it will indicate if your husband’s cancer type is hormone dependent.

I would also recommend you to ask the doctor for how many lymph nodes were dissected (the path report include this). The percentage is important in a case like your husbands’. In my case back in 2000 with open surgery they have dissected 9 nodes, but it is common to take more when patients have high PSA levels before surgery (mine was 24.2).

The reasoning is that cancer leaves the prostate spreading firstly to lymph nodes and then moving to bone at the iliac and far places. In the iliac it forms what is called oligometastatic cancer before becoming systemic. A high number of affected nodes could imply a diagnosis of systemic at far places.
If in fact, the number is small it shows that his case may still be curable with radiotherapy.

Traditional MRI and CT are efficient in revealing cancer when the PSA is high. In your previous post you mentioned that those image studies were negative. I wonder if those tests were done at biopsy when the PSA was low (less than 10). Your husband could get now additional image studies taking the opportunity to get it done with higher resolution equipment (3-tesla) to check for any metastasis. If practical (but not yet required) I would get him to a F18 or C-11 choline PET bone scan to check for far metastasis.

I do not know his age or about any other health problem he may have but in good health I believe that he would like to pursue cure more than “control”, and such can only be achieved with salvage radiotherapy.
Only proper diagnosis can give you assurances on such possibilities.

Meanwhile, the Trelstat shot will control any advancement of the cancer (if it is dependent). Hormonal treatments are very effective as palliative in holding the cancer for long periods of time. An oncologist would then be the proper physician to care his case.

You need to consider that all treatments entail risks and side effects that will interfere with the quality of life. Diet and physical fitness are a must to help in countering the side effects. A copy of this book may help you understanding what I mention above;
“Beating Prostate Cancer: Hormonal Therapy & Diet” by Dr. Charles “Snuffy” Myers; which informs on diagnosis and treatments for systemic cases. This famous oncologist specialized on PCa is himself a survivor of a challenging case on his 13 year of survival, where he battled the bandit with IMRT and ADT (hormonal treatment). He is also a leading oncologist with regards to oligometastatic cancer.

Again, I would recommend you of getting second opinions from proper specialists. I have no medical enrolment. I have a keen interest and enthusiasm in anything related to prostate cancer, which took me into researching and studying the matter since 2000 when I become a survivor and continuing patient.

Be positive. He will beat the bandit again.

Wishing you both the best.

VGama